Why An Annual Assessment?

Annual assessments provide an excellent opportunity to counsel patients about preventive care and to provide or refer for recommended services. These assessments should include screening, evaluation and counseling, and immunizations based on age and risk factors. The interval for individual services varies.

These recommendations, based on age and risk factors, serve as a framework for care which may be provided by a single physician or a team of health care professionals. The scope of services provided by obstetrician–gynecologists in the ambulatory setting will vary from practice to practice. The recommendations should serve as a guide for the obstetrician–gynecologist and others providing health care for women and should be adapted as necessary to meet patients’ needs. This information should not be construed as dictating an exclusive course of treatment or procedure to be followed.

What screening tests are used to screen for breast problems?

What is mammography?

Mammography is an X-ray technique used to study the breasts. No dyes have to be injected or swallowed, and no instru- ments will be put in your body.

Why is mammography done?

Mammography is done for two reasons: 1) as a screening test to regularly check for breast cancer in women who do not have signs or symptoms of the disease, and 2) as a diagnostic test to check lumps or other symptoms that you have found yourself or that have been found by a health care provider.

When should I start having annual mammograms?

Age 40 years is recommended as the starting point in order to find cancer at an early and more treatable stage.

What if the result of my mammography reveals a lump?

Mammography by itself cannot tell whether a lump or other finding is benign (not cancer) or malignant (cancer). If a mammography finding is suspicious for cancer, a biopsy is needed to confirm that cancer is present. In a biopsy, the lump or a small sample of cells from the lump is removed and looked at under a microscope.

How do I prepare for a mammogram?

The day you have a mammogram, do not wear powders, lotions, or deodorants. Most of these products have substances that can be seen on the X-ray and make it hard to read.

What happens during mammography?

To get ready for the test, you will need to completely undress from the waist up and put on a gown. You will be asked to stand or sit in front of the X-ray machine. One of your breasts will be placed between two smooth, flat plastic or glass plates. You will briefly feel firm pressure on your breast. The plates will flatten your breast as much as possible so that the most tissue can be viewed with the least amount of radiation. After the first X-ray, the plates may be removed so that another X-ray can be obtained from one or more other positions. The test then is done on the other breast.

What are the risks of mammography?

You may be concerned about the risk of cancer from the radiation used in mammography. Mammography uses a low level of radiation. The risk of harm from the level of radiation used in mammography is low. Having a yearly screening mammogram does not increase cancer risk.

What is digital mammography?

Digital mammography is a type of mammography technique. It differs from standard mammography only in the way the image is stored. Instead of using film, the image in digital mammography is stored as a digital file on a computer. A computer program allows the image to be enlarged or enhanced or specific areas to be magnified. Digital mammography may be better at detecting cancer in some groups of women, such as those with dense breast tissue, women younger than 50 years, and women who have not gone through menopause.

What is a clinical breast exam?

Your health care provider will examine your breasts during routine checkups. This is called a clinical breast exam. Women aged 29–39 years should have a clinical breast exam every 1–3 years. Women aged 40 years and older should have one every year.

How is a clinical breast exam done?

The exam may be done while you are lying down, sitting up, or both. You may be asked to raise your arms over your head. The breasts are first checked for any changes in size or shape. Your health care provider also looks for puckers, dimples, or redness of the skin. He or she then feels for changes in each breast and under each arm. The nipple may be gently squeezed to check for discharge.

What is breast self-awareness?

Breast self-awareness is an understanding of how your breasts normally look and feel.

How is breast self-awareness different from the traditional breast self-exam?

In the traditional breast self-exam, you use a precise method to examine your breasts on a regular basis, such as once a month. Breast self-awareness does not require you to examine your breasts once a month or with a precise method. Instead, it focuses on having a sense of what is normal for your breasts so that you can tell if there are changes—even small changes—and report them to your health care provider.

Glossary

Benign: Not cancer.

Biopsy: A minor surgical procedure to remove a small piece of tissue that is then examined under a microscope in a laboratory.

Cells:The smallest units of a structure in the body; the building blocks for all parts of the body.

Malignant: A term used to describe cells or tumors that are able to invade tissue and spread to other parts of the body.

Mammography: A procedure that uses X-rays to detect and study breast cancer and other problems of the breast.

Menopause:The time in a woman’s life when the ovaries have stopped functioning; defined as the absence of menstrual periods for 1 year.

Screening Test:A test that looks for possible signs of disease in people who do not have symptoms.

What is cervical cancer screening?

Cervical cancer screening is used to find changes in the cells of the cervix that could lead to cancer (see the FAQ Cervical Cancer). Screening includes the Pap test and, for some women, testing for human papillomavirus (HPV) (see the FAQ Human Papillomavirus [HPV] Infection).

How is cervical cancer screening done?

Cervical cancer screening is simple and fast. It takes less than a minute to do. With the woman lying on an exam table, a speculum is used to open the vagina. This device gives a clear view of the cervix and upper vagina.

For a Pap test, a small number of cells are removed from the cervix with a brush or other tool. The cells are put into a liquid and sent to a lab testing. For an HPV test, sometimes the same sample taken for the Pap test can be used. Sometimes, two cell samples are taken.

Who should have cervical cancer screening and how often?

You should start having cervical cancer screening at age 21 years. How often you should have cervical cancer screening depends on your age and health history:

Women aged 21–29 years should have a Pap test every 3 years.

Women aged 30–65 years should have a Pap test and HPV test (co-testing) every 5 years (preferred). It is acceptable to have a Pap test alone every 3 years.

When can I stop having cervical cancer screening?

You can stop having cervical cancer screening after age 65 if you do not have a history of moderate or severe cervical dysplasia or cervical cancer and if you have had either three negative Pap test results in a row or two negative co-test results in a row within the past 10 years, with the most recent test performed within the last 5 years.

What happens if I have an abnormal screening test result?

You most likely will have additional testing after an abnormal test result. This testing can be simply a repeat Pap test, An HPV test, or a more detailed examination called a colposcopy (with or without a biopsy). If results of follow-up tests indicate precancerous changes, you may need treatment to remove the abnormal cells.

Are cervical cancer screening results always accurate?

As with any lab test, cervical cancer screening test results are not always accurate. Sometimes, the results show abnormal cells when the cells are normal. This is called a “false-positive” result. The tests also may not detect abnormal cells when they are present. This is called a “false-negative” result. Many factors can cause false results:

To help prevent false-negative or false-positive results, you should avoid douching, sexual intercourse, and using vaginal medications or hygiene products for 2 days before your test. You also should not have cervical cancer screening if you have your menstrual period.

Glossary

Biopsy:A minor surgical procedure to remove a small piece of tissue that is then examined under a microscope in a laboratory.

Colposcopy:Viewing of the cervix, vulva, or vagina under magnification with an instrument called a colposcope. Dysplasia: A noncancerous condition that occurs when normal cells are replaced by a layer of abnormal cells. Dysplasia can be mild, moderate, or severe.

Human Papillomavirus (HPV): The name for a group of related viruses, some of which cause genital warts and are linked to cervical changes and cervical cancer.

Pap Test: A test in which cells are taken from the cervix and vagina and examined under a microscope. Speculum: An instrument used to hold open the walls of the vagina.

What is osteoporosis?

Osteoporosis is a condition in which the bones become thin, brittle, and weak. These changes can increase the risk of fractures. Fractures can lead to disability. Fractures caused by osteoporosis have been linked to an increased risk of death.

Is osteoporosis more common in women or in men?

Osteoporosis occurs five times more often in women than in men.

What are some risk factors for osteoporosis?

The following factors cause or contribute to osteoporosis and fractures:

Certain medications

Diseases such as inflammatory bowel disease, rheumatoid arthritis, and lupus

Low calcium intake

Vitamin D insufficiency

Excess vitamin A

High caffeine intake

High salt intake

Aluminum (in antacids)

Alcohol (three or more drinks per day)

Inadequate physical activity or being immobile

Smoking (active or passive)

Falling

Being thin

What is the link between osteoporosis and menopause?

Estrogen, a female hormone, protects against bone loss. After menopause, the ovaries produce very little estrogen. This decrease in estrogen triggers a period of rapid bone loss in women that starts 1 year before the final menstrual period and lasts for about 3 years. The natural effects of aging on bones may contribute to this bone loss as well.

What are some symptoms of osteoporosis?

Osteoporosis may not cause any symptoms for decades. However, some signs and symptoms do occur as the disease progresses. As the spinal bones (vertebrae) weaken, they can fracture. Fracture in the front part of the spinal bones can result in loss of height or a slight curving of the spine. This type of spinal fracture often causes no pain. Sometimes, fractures of the spine can cause pain that travels from the back to the sides of the body.

What is a bone mineral density test?

In a bone mineral density (BMD) test, bone density is measured at the heel, spine, hip, hand, or wrist. Several types of BMD tests are available. Dual-energy X-ray absorptiometry (DXA) of the hip and spine is considered to be the most accurate BMD test available.

Who should have a BMD test?

All women aged 65 years or older should have a BMD test. Women who are younger than 65 years and past menopause should have a BMD test if they have had a bone fracture because of fragile bones or have other risk factors for osteoporosis, such as rheumatoid arthritis, smoking, alcoholism, a history of hip fracture in a parent, or a body weight less than 127 pounds.

How is a DXA scan done?

During a DXA scan, you lie down for 3–10 minutes while a machine scans your body. With this test you are exposed to a small amount of radiation—less than the amount in a normal chest X-ray.

What do DXA scan results mean?

After the test, a T-score is given for each site measured. A negative score means that you have thinner bones than an average 30-year-old woman. A positive score means that you have stronger bones than an average 30-year-old woman. If the T-score at any site is -1 to -2.5, you have a low BMD and are at increased risk of osteoporosis. A score of -2.5 or lower means that you have osteoporosis. Treatment usually is recommended to prevent fractures.

How often should I have a BMD test?

How often you should have your BMD measured depends on your age and results of your previous DXA scan. Women 65 years and older with normal bone mass or mild bone loss can have a test every 15 years. More frequent testing is recommended for women in this age group with T-scores between -1.5 and -2.49.

What is FRAX?

FRAX is a tool used to estimate fracture risk. This computer program helps predict the risk of having a fracture within the next 10 years in women aged 40 years and older who are not taking prescription osteoporosis drugs.

How does FRAX estimate fracture risk?

FRAX takes into account your age, sex, body mass index, smoking, alcohol intake, and other risk factors for osteoporosis. Treatment is recommended if FRAX shows that you have a 3% risk of hip fracture; a 20% risk of a major osteoporotic fracture (fracture of the forearm, shoulder, or spine); or both. FRAX also is used to decide whether women younger than 65 years should have a DXA test. You can calculate your own FRAX by going to http://www.shef.ac.uk/FRAX/.

What treatment is available for osteoporosis?

Various medications are used to treat osteoporosis and help reduce the risk of fractures. Some can be used for prevention.

How can osteoporosis be prevented?

Lifestyle plays a key role in preventing osteoporosis. Exercise, a healthy diet, and not smoking can help keep your bones strong and healthy throughout your life.

When is the best time to start taking care of my bones in order to prevent osteoporosis?

It is never too early to start thinking about bone health. Good bone health should start during childhood. This is the time to focus on building and keeping as much bone as you can through exercise, good nutrition, and staying healthy.

How can exercise help prevent osteoporosis?

Exercise increases bone mass before menopause and slows bone loss after menopause. Bone is living tissue and exercise makes it grow stronger. The Centers for Disease Control and Prevention recommend that healthy adults get 150 minutes of exercise a week, which works out to be about 30 minutes on most days of the week.

What types of exercises help prevent osteoporosis and bone fracture?

Weight-bearing exercises can help keep bones strong. Weight-bearing exercises are activities that are performed while standing and that require your muscles and bones to work against gravity. An example is brisk walking. Non-weight-bearing exercises, such as Tai Chi, Yoga, and Pilates, can build endurance and improve balance and posture, thereby reducing your risk of falls. Strength training also is good for bones. In this type of exercise, muscles and bones are strengthened by resisting against weight, such as your own body, an exercise band, or handheld weights.

How do calcium and vitamin D help build healthy bones?

Calcium is important to building and maintaining healthy bones. Vitamin D helps the body absorb calcium. Many people do not get enough calcium from food. To increase your daily levels of calcium, eat a variety of calcium-rich foods. Good sources of calcium include dark, leafy greens, like spinach, kale, and collards; dairy foods, such as yogurt, milk, and cheese; and canned fish with soft bones, including salmon and sardines. You can increase your intake of vitamin D by eating foods fortified with vitamin D (orange juice, cereal, and milk). You also can get vitamin D by being in the sun for 15 minutes a few days a week.

Glossary

Calcium:A mineral stored in bone that gives it hardness. Estrogen: A female hormone produced in the ovaries.

Hormone:A substance made in the body by cells or organs that controls the function of cells or organs. An example is estrogen, which controls the function of female reproductive organs.

Inflammatory Bowel Disease: The name for a group of diseases that cause inflammation of the intestines. Examples include Crohn disease and ulcerative colitis.

Menopause: The time in a woman’s life when menstruation stops; defined as the absence of menstrual periods for 1 year.

Osteoporosis:A condition in which the bones become so fragile that they break more easily.

Ovaries:Two glands, located on either side of the uterus, that contain the eggs released at ovulation and produce hormones.

Rheumatoid Arthritis:A long-lasting disease that causes pain, swelling, redness, and irritation of the joints and changes in the muscles and bones. In later stages, it can cause bones to become deformed.

Vertebrae: Bones of the spine.

Why is it important to eat a healthy diet?

Your body needs a balanced supply of nutrients to grow, replace worn-out tissue, and provide energy. Not getting enough of these important nutrients can affect your health. However, eating too much food and excess calories can lead to health problems.

How can obesity be harmful to my body?

Obesity increases the risk of cardiovascular disease, diabetes, high blood pressure, and certain types of cancer, including breast cancer, colon cancer, and cancer of the uterus. Obesity also is associated with infertility.

How Can I find a healthy way to eat?

The U.S. Department of Agriculture’s web site “MyPlate” (www.choosemyplate.gov) offers a free diet-tracking program called “SuperTracker” that takes into account your age, sex, height, weight, and physical activity and gives the amount of food you should have each day from each of the following five food groups:

Grains

Fruits

Vegetables

Protein foods

Dairy foods

What is a balanced diet?

A balanced diet should include a combination of proteins, carbohydrates, and fats.

Why is protein important to my body?

Protein provides the nutrients your body needs to grow and repair muscles and other tissues.

What foods are good sources of protein?

Protein is found in the following foods:

Beef, pork, and fish

Poultry

Eggs and dairy products

Beans and peas

Nuts and seeds

How can I get enough protein if I am a vegetarian?

For vegetarians, protein can be found in nuts, seeds, nut butters, and soy products such as tempeh and tofu. Vegetarians who include dairy products in their diets also can get needed protein from milk and eggs.

Why is it important to include fat in my diet?

Some types of fats, called omega-3 fatty acids, play an important role in brain development. Fats also are essential to the function of the immune system, aid in blood clotting, and help your body use vitamins A, D, E, and K.

Do all types of fats have health benefits?

Some have health benefits, while others do not. You should be aware of the different types of fat in your diet:

Saturated fats come mainly from meat and dairy products. They tend to be solid when chilled.

Unsaturated fats tend to be liquid and come mostly from plants and vegetables.

Trans fats are unsaturated fats that have been chemically processed to be solid at room temperature.

What type of fat is best for me?

Most of the fat that you eat should be in the form of unsaturated fat from plant oils.

How can too much fat be bad for me?

Too much saturated fat and trans fat in your diet can lead to abnormal cholesterol levels, which can increase your risk of cardiovascular disease. Excess body fat can lead to several health problems, including diabetes, heart disease, and joint problems.

How can I decrease the amount of fat that I eat?

You also can decrease your fat intake by changing the way you prepare foods:

How does my body use carbohydrates?

All carbohydrates are broken down into glucose, the body’s main fuel that powers all of its activities.

What are the types of carbohydrates?

There are two types of carbohydrates: simple carbohydrates and complex carbohydrates.

What are simple carbohydrates?

Simple carbohydrates are found in naturally sweet foods like fruits and also can be added to foods in the form of table sugar, honey, and syrup. They provide a quick energy boost because they are digested and absorbed rapidly.

Why is it important to limit my intake of simple carbohydrates?

Simple carbohydrates often are high in calories. It is best to avoid sugary drinks and foods with added sugar.

What are complex carbohydrates?

Complex carbohydrates are found in bread, rice, pasta, some fruits, and starchy vegetables such as potatoes and corn. Complex carbohydrates also include dietary fiber. Complex carbohydrates provide longer-lasting energy than simple carbohydrates because it takes your body longer to process them.

What is dietary fiber?

Dietary fiber is found in plant foods. It is the part of the plant that your body cannot digest. Fiber passes relatively unchanged through your digestive system. It can help prevent constipation by adding bulk to the stool, making it easier to pass. Fiber also helps maintain a stable blood glucose level because it passes slowly through the digestive tract. Eating low-glycemic foods can help you feel full and reduce the feeling of hunger, which can aid in weight loss. Low-glycemic foods also may help reduce cholesterol levels and prevent diabetes.

Which foods are good sources of dietary fiber?

The following foods are good sources of dietary fiber:

Fruits

Vegetables

Whole-grain products

Why is calcium important in my diet?

Calcium is needed for healthy bones.

What are good sources of calcium?

Skim milk and other dairy foods, such as yogurt and cheese, are high in calcium. Non-dairy sources of calcium include the following:

Dark greens

Soybeans and some soy products

Certain canned fish and seafood

Cereals and juices with added calcium

Why is vitamin D important in my diet?

Vitamin D helps your body absorb calcium.

What are good sources of vitamin D?

Good sources are milk fortified with vitamin D and fish that have a lot of unsaturated fat, such as salmon. Exposure to sunlight also converts a chemical in the skin to vitamin D.

Why is iron important in my diet?

Iron is needed to make new red blood cells. The most common form of anemia is caused by a lack of iron. Anemia may make you feel tired and weak.

What are good sources of iron?

One serving of most breakfast cereals with added iron should provide enough of this daily requirement. Other foods that are good sources of iron include the following:

Spinach

Beans (soybeans, white beans, lentils, kidney beans, chick peas)

Clams and oysters

Meats (beef, duck, lamb)

Organ meats (liver, giblets)

It helps to eat foods rich in vitamin C, like oranges and tomatoes, at the same meal with an iron-rich food. Vitamin C helps your body use iron better.

Why is folic acid important in my diet?

Folic acid is a B vitamin that also is known as folate. Folic acid improves your overall health and also helps reduce the risk of having a baby with a neural tube defect.

Where can I find the folic acid I need in my diet?

Folic acid is added to certain foods (breads, cereal, pasta, rice, and flour) and is found in leafy dark-green vegetables, citrus fruits, and beans. It may be hard to get all of the folic acid you need from food sources alone. For this reason, it is recommended that all women of childbearing age take a daily supplement containing 400 micrograms of folic acid.

What should I know about sodium?

Sodium is linked to high blood pressure. Sodium should be used in small amounts—about 2,300 mg, or about one teaspoon of table salt, a day. If you are older than 50 years, African American, or have diabetes, high blood pressure, or kidney disease, you should have no more than 1,500 mg a day.

Glossary

Anemia:Abnormally low levels of blood or red blood cells in the bloodstream. Most cases are caused by iron deficiency, or lack of iron.

Calories:Units of heat used to express the fuel or energy value of food. Cardiovascular Disease: Disease of the heart and blood vessels.

Cholesterol:A natural substance that serves as a building block for cells and hormones and helps to carry fat through the blood vessels for use or storage in other parts of the body.

Diabetes:A condition in which the levels of sugar in the blood are too high. Glucose: A sugar that is present in the blood and is the body’s main source of fuel.

Immune System:The body’s natural defense system against foreign substances and invading organisms, such as bacteria that cause disease.

Neural Tube Defect:A birth defect that results from incomplete development of the brain, spinal cord, or their coverings.

Nutrients:Nourishing substances supplied through food, such as vitamins and minerals.

Obesity: A condition characterized by excessive body fat.

Uterus:A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Weight Control: Eating Right and Keeping Fit

A healthy weight is good for your physical and mental well-being. Good eating habits and moderate exercise are crucial to keeping a healthy weight and a fit body. Being overweight—weighing too much in relationship to your height—is a problem for many people. If you are overweight, you have an increased risk of several health problems. The good news is that you can reduce these risks by losing weight.

The body mass index (BMI) is a tool that often is used to measure body fat. It is based on height and weight. To find out your BMI, our online calculator under "Weight Loss".

A person with a BMI of 18.5–24.9 is a normal weight. A person with a BMI of 25.0–29.9 is overweight, and a person with a BMI of 30.0 or higher is obese. About one third of women in the United States are obese.

If you are overweight or obese, you also should measure your waist size. Extra fat in the abdomen (an “apple” shape) is a greater health risk than extra fat in the hips and thighs (a “pear” shape). To measure your waist, stand up and place a tape measure around your middle, just above your hip bones. Take the measurement just after you breathe out. If your waist size is 35 inches or greater, your risk of certain health issues associated with being overweight is increased (see “Health Risks of Being Overweight”).

Factors That Effect Weight:

Every function of the body—from building cells to moving muscles—needs energy. Energy is measured in calories. Calories also measure how much fuel is in a certain food. The body uses only as many calories as it needs for energy. Any calories that are left over are stored as fat in the body.

Eating more calories than you use up is the most important factor that leads to weight gain. Some other factors include the following:Age—It is normal to gain a little weight as you grow older. You may not be as active as you were when you were younger. If you do not adjust your food intake, you may put on extra weight. Even as little as 100 extra calories a day can add up to an unhealthy weight.Genes—Genes may affect a person’s weight directly or indirectly. Some people have genetic disorders that lead to obesity. Others are at increased risk because being overweight or obese runs in their families.Pregnancy—After having a baby, a woman might not lose all of the weight she gained during pregnancy. If this happens with each pregnancy, the weight can add up.

Health Risks of Being Overweight:

Many serious health problems are linked to being overweight or obese. Cardiovascular disease is the name given to a variety of conditions that involve the heart and blood vessels. Diabetes is a disease in which the level of glucose (sugar) in the blood is too high. In the most common type of diabetes (type 2 diabetes), the body’s cells are resistant to the effects of a hormone called insulin. Insulin is the chemical in the body that carries glucose to the body’s cells.

Both cardiovascular disease and diabetes are related to a condition called metabolic syndrome. Metabolic syndrome is a combination of factors that includes high blood pressure, low levels of “good” cholesterol, a waist measurement of at least 35 inches (for women), and higher-than-normal levels of glucose and triglycerides in the blood. You have metabolic syndrome if you have at least three of these factors.

Besides cardiovascular disease and diabetes, being overweight or obese is associated with the following additional health problems:Gallbladder diseaseCertain types of cancer, such as cancer of the endometrium, breast, colon, and gallbladder; obesity also may increase the risk of ovarian cancer.Sleep apneaJoint diseaseInfertility

Excess weight also can affect pregnancy. Women who are overweight or obese are at a higher risk of diabetes and high blood pressure during pregnancy than women of normal weight. These women also are more likely to have a cesarean delivery.

Losing Extra Weight

If you are overweight or obese, losing weight will have many benefits for your health and well-being. Even a modest weight loss of 5–10% of your body weight can have a positive effect.

To lose weight, you need to use up more calories than you take in. You can do this by getting regular exercise combined with a program of healthy eating. Losing weight this way usually is gradual. Think of losing weight as a lifestyle change. Once you lose weight, you need to be able to keep it off. You may lose weight more quickly with a “crash” diet, but these diets are not meant to be permanent. You are more likely to gain back the weight you lost if you go on a crash diet rather than make long-term lifestyle changes.

Nutrition

Healthy eating should be the first step in weight loss. It is important to get the nutrients your body needs to replace worn-out tissue and to provide energy. The U.S. Department of Agriculture’s web site “MyPlate” (www.choosemyplate.gov) can help you plan a balanced diet. It offers a diet-tracking program called “SuperTracker” that takes into account your age, sex, height, weight, and physical activity and gives the amount you should have each day from each of these five food groups:GrainsVegetablesFruitsDairy foodsProtein foods

MyPlate makes it easy to remember what to eat at each meal. One half of your plate should be fruits and vegetables. The other half should be grains and protein foods. Try to make at least one half of the grains you eat whole grains (for example, whole-wheat bread, brown rice, and oatmeal). Eat more foods that are naturally low in fat, such as low-fat or non-fat milk, many types of fish, and leafy vegetables. Limit your intake of processed low-fat foods. Often, low-fat cookies and chips are high in sugar and salt to make them taste good. Read food labels carefully.

Reading Food Labels

All packaged foods must be clearly labeled with nutrition information. Reading all food labels can help you make smart food choices. The labels will tell you how many calories and the amount of nutrients that are in each serving.

Serving Size: The amount of the food in one serv­ing. The information on the label refers to this amount of food.

Saturated Fat: This type of fat comes mainly from meat and milk products. It tends to be solid when chilled—like butter and lard, for instance. Short-ening, palm oil, and coconut oil also are saturated fats.

Trans Fat: This is a kind of saturated fat. Trans fat is made when liquid oil is turned into solid fat like shortening and hard margarine. This is done to make foods last longer and give them better flavor. Vegetable shortenings, some margarines, crackers, cookies, and snack foods like potato chips contain trans fat.

Percent Daily Values: The percentage of nutrients this product provides based on the daily recommended intake (DRI), which is the amount that you should consume of this nutrient each day. It is based on a diet of 2,000 calories.

Eat fewer foods that are high in sugar and fat. An easy way to cut calories and to reduce the amount of sugar you eat is to avoid sugary drinks, such as soft drinks and sweetened tea.

Weight loss is not only about what you eat, but how much you eat. Portion control is key. When trying to lose weight, pay attention to the total number of calories you consume. Eat smaller amounts of all foods. For example, a 3-ounce serving of meat or poultry is the size of a deck of cards. A tablespoon of butter is about the size of a poker chip.

Exercise

Regular exercise has many benefits. It promotes general health, increases mental well-being, and helps you maintain a healthy weight. Your endurance increases, as does your flexibility and muscle strength. Exercise can help reduce symptoms of depression and anxiety in some people. Your risk of heart disease, colon cancer, and diabetes decreases with regular physical activity.

Getting enough physical activity does not mean that you have to join a gym or play a sport. Brisk walking is an easy and inexpensive way to be physically active. It also is a good way to lose weight. According to a large study of people who have lost weight and kept it off, walking was the most frequently reported exercise.

People who have lost weight and kept it off generally get 60–90 minutes of moderate intensity activity on most days of the week. You do not have to do this all at once. For instance, you can exercise for 20–30 minutes three times a day. The box “Common Physical Activities” lists some examples of moderate and vigorous physical activities.

It may be a good idea to talk to your health care provider before starting an exercise program. If you are obese, pregnant, older than 50 years, or have a medical condition and have not exercised for a while, you definitely should discuss how to ease into a safe exercise program.

Moderate activities are those in which your breathing and heart rate are faster than normal but you can still have a conversation:

Walking briskly (a 15-minute mile) or hikingLight yard work (raking or bagging leaves or using a lawn mower)Actively playing with childrenBiking (less than 10 mph)

Vigorous activities are those in which your heart rate is even higher and you are breathing too hard to have a conversation:

Why is it hard for me to loose weight?

Many women report that it is hard for them to lose weight. No matter how much they cut down on their food intake and how much they exercise, they still cannot seem to shed the extra pounds. What is going on? Experts looking into this problem have proposed several different reasons for why weight loss may be difficult for some women:

Lack of sleep. Getting less than 6–8 hours of sleep a night may be linked to higher levels of body fat.Your body’s set point. Some research suggests that the body regulates the amount of fat that is stored to stay within a certain weight range—the so-called “set point.” When you eat fewer calories than you usually do, you lose weight. However, once you stop eating fewer calories, you regain the lost pounds and return to your original weight. The set-point idea often is used to explain why dieting is not a good strategy for permanent weight loss.

Loss of muscle. As we age, we tend to lose muscle. Muscle burns calories at a faster rate than fat. As muscle is lost, calories are burned more slowly. If you do not take in fewer calories as you approach midlife, you may gain weight.

Hormones. The female hormones estrogen and progesterone may influence how fat is stored and distributed in the body. Hormones that control appetite also have been discovered. Levels of these hormones may be influenced by the type of food that is eaten and at what time of day it is eaten.

Talk with your health care provider if you are having trouble losing weight and keeping it off. You also can try one or more of the following strategies:

Do not start a diet that you cannot realistically stick with for the rest of your life. If you plan only to follow a certain plan until you lose weight and then return to your “normal” way of eating, you may find yourself regaining all of the weight that you lost.

Instead of reducing portions of all foods, eat larger portions of foods that are low in calories, such as vegetables, salads, and broth-based soups, and smaller portions of high-fat and high-calorie foods, such as french fries, desserts, and fatty meats. Eating a salad before a meal can help satisfy your hunger and reduce the number of calories that you take in. Using SuperTracker can help you identify where you could add more low-calorie foods and where you could cut back on high-fat options.

Medication

For some people, it may be hard to lose weight through diet and exercise alone. If you have a BMI greater than 30, or a BMI of at least 27 with certain medical conditions, such as diabetes or heart disease, medications may be able to help you lose weight. These medications should be combined with a healthy eating plan and regular physical activity.

There are several types of government-approved weight-loss medications available by prescription. They each work in different ways in the body and have different side effects. Your health care provider will be able to advise you about the type of medication that is best for you and how to manage side effects.

Surgery

If diet and exercise do not work, a special type of surgery, bariatric surgery, may be an option for people who are very obese (a BMI of 40 or greater) or who have a BMI between 35 and 39 and also have major health problems caused by obesity. Bariatric surgery can result in significant weight loss. This may decrease the risk of the serious health problems associated with obesity.

Bariatric surgery can be divided into two main types: 1) those that reduce the amount of food the stomach can hold (called restrictive surgery) and 2) those that change the way food is absorbed through the intestines (called malabsorptive surgery). Each type of surgery has different benefits, risks, and success rates, which you should discuss in detail with your health care provider. Weight loss with restrictive surgery tends to be slow and steady, while weight loss with malabsorptive surgery may be more rapid and significant.

This surgery may have long-term effects on your body, such as changes in bowel habits and eating patterns. You should not have this surgery unless you are committed to making lifestyle changes, including restricting your diet and exercising regularly. You may need to take vitamin and mineral supplements, such as vitamin B12 and iron, for the rest of your life. If you do have weight loss surgery, you should delay getting pregnant for 12–24 months after surgery, when you will have the most rapid weight loss.

Risks Can Include:Leaking of stomach juices into the abdomenInjury to other organs, such as the spleenWearing away of the band or staples used in the surgeryInfectionComplications from anesthesiaDeath

Maintaining Your Weight

Keeping the lost weight off may be harder than losing it. Maintaining a healthy weight requires a lifelong commitment to good nutrition and exercise. You need to make healthy food choices, eat moderate portions, and build physical activity into your daily life. Most people who lose weight and keep it off stick to a low-fat, low-calorie diet. They also keep up a high level of physical activity. In addition, the following strategies may help you maintain your weight loss:Eat breakfast every day.Weigh yourself at least once a week.Watch fewer than 10 hours of television per week.Exercise on average 1 hour per day.

Finally…The keys to weight control are to adopt good eating habits and to get regular exercise. Eat foods that are rich in nutrients but low in calories. Choose exercise that you like and make it a part of your daily routine. Make a balanced diet and exercise long-term habits. You will enjoy the benefits for the rest of your life.

Glossary

Anesthesia:Relief of pain by loss of sensation.

Bariatric Surgery:Surgical procedures that cause weight loss for the treatment of obesity.

Body Mass Index (BMI):A number calculated from height and weight that is used to determine whether a person is underweight, normal weight, overweight, or obese.

Calories:Units of heat used to express the fuel or energy value of food.

Cardiovascular Disease: Disease of the heart and blood vessels.

Cells: The smallest units of a structure in the body; the building blocks for all parts of the body.

Cesarean Delivery:Delivery of a baby through surgical incisions made in the mother’s abdomen and uterus.

Cholesterol:A natural substance that serves as a building block for cells and hormones and helps to carry fat through the blood vessels for use or storage in other parts of the body.

Diabetes: A condition in which the levels of sugar in the blood are too high.

Endometrium: The lining of the uterus.

Estrogen: A female hormone produced in the ovaries.

Genes: Segments of DNA that contain instructions for the development of a person’s physical traits and control of the processes in the body. They are the basic units of heredity and can be passed down from parent to offspring.

Glucose:A sugar that is present in the blood and is the body’s main source of fuel.

Hormone: A substance made in the body by cells or organs that controls the function of cells or organs. An example of a hormone is estrogen, which controls the function of female reproductive organs.

Infertility: A condition in which a couple has been unable to get pregnant after 12 months without the use of any form of birth control.

Insulin:A hormone that lowers the levels of glucose (sugar) in the blood.

Metabolic Syndrome:A combination of factors including elevated blood pressure, waist circumference of 35 inches or greater, higher-than-normal blood glucose level, lower-than-normal levels of “good” cholesterol, and high levels of fats in the blood (triglycerides) that contributes to both diabetes and heart disease.

Nutrients:Nourishing substances supplied through food, such as vitamins and minerals.

Progesterone:A female hormone that is produced in the ovaries and that prepares the lining of the uterus for pregnancy.

Sleep Apnea: A disorder characterized by interruptions of breathing during sleep that can lead to other health problems.

Triglycerides:A form of body fat found in the blood and tissues. High levels are associated with cardiovascular disease

What is a preconception care checkup?

The goal of this checkup is to find things that could affect your pregnancy. Identifying these factors before pregnancy allows you to take steps that can increase the chances of having a healthy pregnancy and a healthy baby. During this visit, your health care provider will ask about your diet and lifestyle, your medical and family history, medications you take, and any past pregnancies.

Who should have a preconception care checkup?

If you are planning to become pregnant, it is a good idea to have a preconception care checkup. The first 8 weeks of pregnancy are key for the baby growing inside you. Most of the baby’s major organs and body systems have begun to form. Your health and nutrition can affect your baby’s growth and development in these early weeks.

Why is a healthy diet important?

Your body needs a regular supply of nutrients to grow, replace worn-out tissue, and provide energy. How much of each nutrient you need each day is called the dietary reference intake. You can get your daily dietary reference intake of nutrients from food as well as from supplements. However, most of your nutrients should come from the foods you eat.

How can I make sure my diet is healthy?

To be sure that your diet gives you enough nutrients, you need to know which ones are in the foods you eat. The U.S. Department of Agriculture’s food-planning guide called MyPlate (www.choosemyplate.gov) can help you make healthy food choices. MyPlate takes into account your age, sex, and how much you exercise every day.

How can being overweight affect my pregnancy?

Excess weight during pregnancy is associated with several pregnancy and childbirth complications, including high blood pressure, preeclampsia, preterm birth, and gestational diabetes. Obesity during pregnancy also is associated with macrosomia, defined as a larger than normal baby, as well as an increased risk of birth injury and cesarean delivery. It also increases the risk of birth defects, especially neural tube defects (NTDs). Having too much body fat may make it more difficult for your health care provider to monitor your baby with ultrasound and to hear the baby’s heartbeat.

How can I lose weight if I am overweight?

To lose weight, you need to use up more calories than you take in. The best way to lose weight is by making a few changes in your diet and by being more physically active. Cutting back on the number of calories you consume is a good first step. Exercise burns calories and helps you lose weight. In certain situations, medications or weight-loss surgery can be considered.

How can being underweight affect my pregnancy?

Being underweight also poses risks during pregnancy. It increases the risk of having a low birth weight baby. These babies are at risk of problems during labor and may have health and behavioral problems that last into childhood and adulthood. Being underweight during pregnancy also increases the risk of preterm birth.

Should I take a vitamin supplement?

Although most of your nutrients should come from the foods you eat, it is a good idea to start taking a prenatal vitamin supplement before pregnancy. Prenatal vitamin supplements contain all the recommended daily vitamins and minerals you will need before and during your pregnancy.

Why is it important for me to get enough folic acid before I get pregnant?

Folic acid helps prevent NTDs when taken before pregnancy and for the first 3 months of pregnancy. It is recommended that all women (even if they are not trying to get pregnant) consume 0.4 milligrams (400 micrograms) of folic acid a day.

Why is it important for me to get enough iron?

Iron also is important during pregnancy. It is used to make the extra blood needed to supply oxygen to the baby. Not getting enough iron can be a problem for some women.

Can my lifestyle affect my pregnancy?

Smoking, drinking alcohol, and drug use during pregnancy can have harmful effects on a baby’s health. The time when the fetus is most vulnerable to the harmful effects of these substances is during the first trimester of pregnancy. Stopping harmful behavior before pregnancy may reduce or even eliminate the risks of some birth defects that occur early in pregnancy.

How can my environment affect my pregnancy?

Some substances found in the home or the workplace may make it harder for a woman to conceive or could harm her fetus. If you are planning to get pregnant, look closely at your home and workplace. Think about the chemicals you use in your home or garden. Find out from your employer whether you might be exposed at work to toxic substances such as lead or mercury, chemicals such as pesticides or solvents, or radiation.

Can medical conditions I have affect my pregnancy?

Some medical conditions—such as diabetes, high blood pressure, depression, and seizure disorders—can cause problems during pregnancy. If you have a medical condition, your health care provider will discuss with you the changes that you need to make in order to bring your condition under control before you try to get pregnant.

Can the medications I take affect my pregnancy?

Some medications, including vitamin supplements, over-the-counter medications, and herbal remedies, can be harmful to the fetus and should not be taken while you are pregnant. It is important to tell your health care provider about all of the medications you are taking during your preconception care checkup. Do not stop taking prescription medication until you have talked with your health care provider.

If I have an infection, can it affect my pregnancy?

Infections can harm both the mother and the fetus. Some infections during pregnancy can cause birth defects or illnesses in the baby.

Infections passed through sexual contact—sexually transmitted diseases (STDs)—also are harmful during pregnancy. Many types of STDs may affect your ability to become pregnant. They also may infect and harm your baby. If you think you or your partner may have an STD, get tested and treated right away.

Can I prevent infections?

Vaccination (also called immunization) can prevent some infections. Some vaccines are not safe to use during pregnancy. It is important to know which vaccines you may need and to get them before becoming pregnant.

What if I had a problem with a previous pregnancy?

Some pregnancy problems may increase the risk of having the same problem in a later pregnancy. These problems include preterm birth, high blood pressure, preeclampsia, and gestational diabetes. However, just because you had a problem in a past pregnancy does not mean it will happen again—especially if you receive proper care before and during your pregnancy.

Why is it important for my partner and me to share our family health histories with my health care provider?

Some health conditions occur more often in certain families or ethnic groups. These conditions are called genetic or inherited disorders. If a close relative has a certain condition, you or your baby could be at greater risk of having it.

Glossary

Calories: Units of heat used to express the fuel or energy value of food.

Depression: Feelings of sadness for periods of at least 2 weeks.

Diabetes: A condition in which the levels of sugar in the blood are too high.

Fetus: The developing offspring in the uterus from the ninth week of pregnancy until the end of pregnancy.

Gestational Diabetes: Diabetes that arises during pregnancy.

Neural Tube Defects (NTDs): Birth defects that result from incomplete development of the brain, spinal cord, or their coverings.

Nutrients: Nourishing substances supplied through food, such as vitamins and minerals.

Preeclampsia: A condition of pregnancy in which there is high blood pressure and protein in the urine.